J Cerebrovasc Endovasc Neurosurg.  2025 Mar;27(1):71-79. 10.7461/jcen.2024.E2024.05.003.

Radial artery access with a sheathless 0.087” inner diameter balloon guide catheter (Walrus) for neurointerventional procedures: Technique and clinical outcomes

• Levinson S
• Pendharkar A
• Gauden A
• Pulli B

• KMID: 2567046
• DOI: http://doi.org/10.7461/jcen.2024.E2024.05.003

Abstract

Intro: There is a growing preference among neurointerventionalists for transradial access (TRA) over transfemoral access (TFA) due to improved patient satisfaction, recovery time and reduced access site complication, but using balloon guide catheters (BGCs) in the radial artery remains a challenge. We report our experience in successfully using the 0.087” inner diameter Walrus BGC without a sheath via the radial artery for non-emergent neurointerventions.
Objective
Describe the technique for safely accessing the radial artery using the sheathless Walrus balloon guide catheter
Methods
A retrospective chart review of thirteen consecutive patients who underwent intervention with radial artery access with a sheathless Walrus BGC was performed.
Results
All twelve procedures were performed successfully with no instances of conversion from TRA to TFA. There were no significant procedural or access site complications. The mean radial diameter was 2.51 mm.
Conclusions
The Walrus 0.087” ID BGC is an effective tool that can safely be used via the radial artery using a sheathless approach, which helps to maximize the size of the catheter that can be used. This is the first instance of our knowledge of this technique being utilized for neurointerventions and therefore could be used to expand the indications for TRA for a wider range of procedures.

Keyword

Stroke; Endovascular procedures; Intracranial atherosclerosis; Transradial access; Balloon guide catheter; Walrus

Figure

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  Fig. 1. Patient #3 with symptomatic high-grade left internal carotid artery stenosis. (A) Roadmap angiogram of the right radial artery after access. (B-C) Walrus catheter tracking over the wire within the common carotid artery (yellow arrows) and advancement to final position. (D) Pretreatment angiogram of the left common carotid artery, yellow arrows showing the site of severe focal stenosis at the carotid bifurcation. (E) Inflated balloon as the lesion is crossed with the microwire to minimize thromboembolic events. (F) Balloon used as anchor during stent advancement to prevent balloon guide catheter prolapse into the aortic arch. (G) Post intervention angiogram of the left common carotid artery demonstrates no significant residual stenosis after stent placement.

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  Fig. 2. Patient #7 with acutely symptomatic left internal carotid dissection. (A-B) Walrus catheter tracking within the left common carotid artery over the diagnostic catheter and wire. (C) Left common carotid angiogram demonstrates left ICA dissection with intramural thrombus resulting in occlusion of the left Internal Carotid Artery (ICA). (D) Pretreatment angiogram of left ICA circulation demonstrates no intracranial large vessel occlusion. (E) Walrus catheter inflation to increase the stability of the balloon guide catheter for stent delivery and deployment. (F) Native view of stent construct. (G, H) Post treatment left common carotid angiogram demonstrates widely patent stent construct with reconstitution of left ICA, no significant residual stenosis, and brisk intracranial flow without distal thromboembolic complication.

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